Back and Cervical Pain – Bulging Disc and the C and P Exam ROM Test

I have a C&P coming up in October for Neck/Back pains. While in Iraq in 2004, I fell off of a 916 semi-truck and have buddy statements to verify this. I also have medical proof that I went to the TMC in theater and it was considered a “sprain” and was given light duty for a few days. In my medical records from the field hospital in Iraq, it states that this the back injury is service connected. When I returned home in 2005, I went to the VA and had MRI’s done that confirmed I had a bulging disc going away from my spine. Since 2005, I have dealt with varying levels and range of motion and pain. My family doctor wrote a Stressor statement for me that he has been treating me for a Bulging Disc and believes that is it Service Connected. My Family Doctor is also a DR in the Army Reserves. My concern is that I have constant lower back pain due to the bulging disc, but if forced to try and ignore the pain, my ROM may appear to be better than it is, especially if PAIN is considered a much less gauge when testing for SC back problems.

I have read on many forums that ROM is the main test used to determine a SC rating, but if that range is done in PAIN, will they take that into consideration. I do not want to do anything that would seem shady or lying, I simply want what is owed to me for my service and the injuries I incurred while in theater. Should I state that I have constant lower back pain in varying levels of pain when testing my ROM? I’m concerned after reading many post that pain is not the primary assessment tool used but rather ROM. If your able to move your neck and back but am always in pain, what’s that say? Should I stop when the pain occurs? Rodney

I can only speak as a licensed massage therapist, but, I’ve witnessed ROM exams before. Usually common sense, which I know is not very common, should prevail. But you should inform anybody testing or touching you before they touch you about your injury and request that they DO NOT HURT YOU. Do this without drama, its a fairly reasonable request.

A good tester should ask when is the pain felt? and to what degree of pain? Like you said, just be honest – don’t exaggerate, and do not understate your pain either. Usually they will try to find first pain range and take you to a reasonable limit – but it will be both of your jobs to keep communicating. You should not be brought to severe pain. So, yes, your pain indication is taken into account during ROM testing. But so is the credability of your response — the examiner will also evaluate if your embellishing or exaggerating. Just be honest. Real Simple.

Generally, there are 2 types of ROM tests. Passive: When they move your limbs and Active, where they test your own ability to move. Either way. Tell them when it hurts. No drama. Here is a great clip to see if your faking, they very well may do this on you.

Regarding your family doctor statements. He needs to use different language than just “believes” its service connected.

VA requires more than “belief.” Terms such as “more likely than not” and he should state the actual injury as the event. Use the dates of injury. Also, having disc bulges are not in and of itself a nexus as many people have bulges without pain. Back pain science is very much in disagreement. So the MRI in 2005 doesn’t prove the bulge was caused by your injury – only you have a disc bulge. And please, I do understand your situation. The best documentation for you will be to have a specialist, such as an Orthopedic Dr, state your current condition, your pain, your physical (and even mental) limitations and also state that you incurred the injury (just as you mentioned it) and he opines this injury is “more likely than not” causing your disability.

Hell – he might write its definitely causing it. But not necessary. I’m sure the rest of the message board gives all the legal jargon pretty much the same. Mikey5311